Day care comprises medical and paramedical services delivered to patients that are formally admitted for diagnosis, treatment or other types of health care with the intention of discharging the patient on the same day. An episode of care for a patient who is admitted as a day care patient and subsequently stays overnight is classified as an overnight stay or other in-patient case. Services for non-admitted patients that are extended to formal admission for day care are considered as day care. A day patient (or “same-day patient”) is usually admitted and then discharged after staying between 3 and 8 hours on the same day. Day care is usually performed in institutions or wards specialised for this kind of care (for example elective surgery).
[Source: OECD. A System of Health Accounts]

DE-LISTING

Exclusion of a medicine from a medicine list (e.g. positive list), often resulting in exclusion from reimbursement.
[Source: PPRI Glossary]

DEDUCTIBLE

Initial expense up to a fixed amount which must be paid out-of pocket for a service or over a defined period of time by an insured person; then all or a percentage of the rest of the cost is covered by a third party payer.
See also: out-of pocket payments

DEFINED DAILY DOSE (DDD)

The DDD is a unit of measurement defined as the assumed average maintenance dose per day for a pharmaceutical used for its main indication in the adult. A DDD will normally not be assigned for a substance before a product is approved and marketed in at least one country. The basic principle is to assign only one DDD per route of administration within an ATC code. DDDs for plain substances are normally based on monotherapy. Doses for individual patients and patients groups will often differ from the DDD. DDD does not necessarily reflect the recommended or Prescribed Daily Dose.
DDDs are not established for topical products, sera, vaccines, antineoplastic agents, allergen extracts, general and local anaesthetics and contrast media.
[Source: WHO Collaborating Centre for Drug Statistics Methodology – Guidelines for ATC classification and DDD assignment]

DELIVERY CHAIN

A delivery chain is the system of organisations, people, technology, activities, information and resources involved in moving a product or service from supplier to customer. Delivery chain activities in the pharmaceutical sector involve transformation of natural resources, raw materials and components into a finished pharmaceutical that is delivered to the patient or customer.

DIAGNOSIS RELATED GROUPS (DRG)

A classification system of hospital cases used to pay hospital services, regardless of the cost to the hospital to provide services.
The system is based not on the severity of the disease but on the amount of resources consumed.
It categorises illness by diagnosis and treatment. A specific software (“grouper”) groups patients into “homogeneous groups” on the basis of diagnosis at discharge (coded by the International Classification of Diseases) and modified by the presence of a surgical procedure, patient age, presence or absence of significant comorbidities or complications, and other relevant criteria.

DIRECT PAYMENTS

Payments for goods and services which are not covered by a third party payer (including self-medication).
[Source: adapted from PPRI Glossary]

DISABILITY-ADJUSTED LIFE YEARS (DALYS)

A measure of the burden of disease on a defined population and the effectiveness of the intervention. DALYs are advocates as an alternative to QALY and claimed to be a valid indicator of population health.
They are based on adjustment of life expectancy to allow for long term disability as estimated from official statistics. However their use as currently expressed and calculated may be limited because the necessary data are not available or do not exist. Moreover, the concept postulates a continuum from disease to disability to death that is not universally accepted.
[Source: Last. A dictionary of epidemiology edited for the International Epidemiological Association]

DISCOUNT

A price reduction granted to specified purchasers of a pharmaceutical product under specific conditions.
[Source: OECD. Pharmaceutical Pricing Policies in a Global Market]

DISEASE

A failure of the adaptive mechanisms of an organism to counteract adequately, normally or appropriately to stimuli and stresses to which the organism is subjected, resulting in a disturbance in the function or structure of some part of the organism. This definition emphasises that disease is multifactorial and may be prevented or treated by changing any or a combination of the factors.
[Source: WHO. A Glossary of Terms for Community Health Care and Services for Older Persons]

DISEASE-SPECIFIC REIMBURSEMENT

Eligibility for reimbursement is linked to the underlying disease which shall be treated.
[Source: PPRI Glossary]

DISPENSING

To supply a clinically appropriate medicine to a patient or care giver, usually against a written prescription, for self-administration or administration by another professional, and to advise on safe and effective use.
[Source: Global Conference on the Future of Hospital Pharmacy]

DISPENSING DOCTORS

Physicians who have been granted the right to dispense medicines to their patients.
[Source: PPRI Glossary]

DISPENSING FEE

Normally a fixed fee that pharmacies are allowed to charge per prescribed item instead of or in addition to a percentage mark-up. The fee more accurately reflects the work involved in dispensing a prescription; a percentage mark-up makes profit dependent on the sale of expensive medicines.

The division and movement of pharmaceutical products from the premises of the manufacturer of such products, or another central point, to the end user thereof, or to an intermediate point by means of various transport methods, via various storage and/or health establishments.
[Source: WHO. Good distribution practices (GDP) for pharmaceutical products]

DISTRIBUTION ACTORS

Persons or entities who are involved in the supply, delivery and logistics management of medicines (e.g. wholesalers, importers).
Some distribution actors are also allowed to dispense medicines (e.g. pharmacists, dispensing doctors).